Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD

Helen Viggers, Philippa Howden-Chapman, Tristram Ingham, Ralph Chapman, Gina Pene, Cheryl Davies, Ann Currie, Nevil Pierse, Helen Wilson, Jane Zhang, Michael Baker, Julian Crane, Helen Viggers, Philippa Howden-Chapman, Tristram Ingham, Ralph Chapman, Gina Pene, Cheryl Davies, Ann Currie, Nevil Pierse, Helen Wilson, Jane Zhang, Michael Baker, Julian Crane

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether a NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial.

Methods: Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants' houses were retrofitted with insulation. After baseline data were received, participants were randomised to either 'early' or 'late' intervention groups. The intervention was a voucher of $500 directly credited to the participants' electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers.

Discussion: This community trial has successfully enrolled 522 older people with COPD. Baseline data showed that, despite having a chronic respiratory illness, participants are frequently cold in their houses and economise on heating.

Trial registration: The clinical trial registration is http://NCT01627418.

Figures

Figure 1
Figure 1
Flow of participants through the study.
Figure 2
Figure 2
Study timeline. The wave design and randomisation meant that the interventions were spread over three years.

References

    1. Broad J, Jackson R. Chronic Obstructive Pulmonary Disease and Lung Cancer in New Zealand: A report prepared for the Thoracic Society of Australia and New Zealand. .
    1. World Health Organization. World Health Statistics 2008. Geneva; 2008.
    1. Anto JM, Vermeire P, Vestbo J, Sunyer J. Epidemiology of chronic obstructive pulmonary disease. Eur Respir J. 2001;17:982–994. doi: 10.1183/09031936.01.17509820.
    1. Prescott E, Godtfredsen N, Vestbo J, Osler M. Social position and mortality from respiratory disease in males and females. Eur Respir J. 2003;21:821–826. doi: 10.1183/09031936.03.00047502.
    1. Hegewald MJ, Crapo RO. Socioeconomic Status and Lung Function. Chest. 2007;132:1608–1614. doi: 10.1378/chest.07-1405.
    1. Martinez FJ, Donohue JF, Rennard SI. The future of chronic obstructive pulmonary disease treatment- difficulties of and barriers to drug development. Lancet. 2011;378:1027–1037. doi: 10.1016/S0140-6736(11)61047-7.
    1. Halpin DM. Health Economics of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc. 2006;3:227–233. doi: 10.1513/pats.200507-072SF.
    1. National Heart Lung and Blood Institute. Morbidity & Mortality: 2004 Chart Book on Cardiovascular, Lung, and Blood Diseases. Bethseda MD; 2004.
    1. Crockett AJ, Cranston JM, Moss JR. Economic Case Statement: Chronic Obstructive Pulmonary Disease (COPD) The Australian Lung Foundation; 2002. .
    1. The Australian Lung Foundation Case Statement. Chronic Obstructive Pulmonary Disease (COPD) 2001. .
    1. Montnemery P, Bengtsson P, Elliot A, Lindholm E-H, Nyberg P, Lofdahl C-G. Prevalance of obstructive lung diseases and respiratory symptoms in relation to living environment and socio-economic group. Respir Med. 2001;95:744–752. doi: 10.1053/rmed.2001.1129.
    1. Garcia-Aymerich J, Monso E, Marrades RM, Escarrabill J, Felez M, Sunyer J, Anto JM. EFRAM investigators. Risk Factors for Hospitalization for a Chronic Obstructive Pulmonary Disease Exacerbation: EFRAM Study. Am J Respir Crit Care Med. 2001;164:1002–1007.
    1. Chaix B, Rosvall M, Lynch J, Merlo J. Disentangling contextual effects on cause-specific mortality in a longitudinal 23-year follow-up study: impact of population density or socioeconomic environment. Int J Epidemiol. 2006;35:633–643. doi: 10.1093/ije/dyl009.
    1. Matteell G, Scognamaiglio A, Pistelli F, Baldacci S, Carrozzi L, Viegi G. Chronic obstructive pulmonary disease epidemiology. Minerva Pneumologica. 2003;42:67–84.
    1. Prescott E, Lange P, Vestbo J. Copenhagen heart study group: Socioeconomic status, lung function, and admission to hospital for COPD: results from the Copenhagen City Heart Study. Eur Respir J. 1999;13:1109–1114. doi: 10.1034/j.1399-3003.1999.13e28.x.
    1. Prescott E, Vestbo J. Socioeconomic status and chronic obstructive pulmonary disease. Thorax. 1999;54:737–741. doi: 10.1136/thx.54.8.737.
    1. Rasmussen FV, Borchsenius L, Winslow JB, Ostergaard ER. Associations between Housing Conditions, Smoking Habits and Ventilatory Lung Function in Men with Clean Jobs. Scand J resp Dis. 1978;59:264–276.
    1. Mackenbach JP, Howden-Chapman P. Houses, neighbourhoods and health. European J Public Health. 2002;12:161–162. doi: 10.1093/eurpub/12.3.161.
    1. Cao Z, Ong KC, Eng P, Tan WC, Ng TP. Frequent hospital readmissions for acute exacerbation of COPD and their associated factors. Respirology. 2006;11:188–195. doi: 10.1111/j.1440-1843.2006.00819.x.
    1. Osman LM, Ayres JG, Garden C, Reglitz K, Lyon J, Douglas JG. Home Warmth and health status of COPD patients. European J Public Health. 2008;18:399–405. doi: 10.1093/eurpub/ckn015.
    1. Osman LM, Ayres JG, Garden C, Reglitz K, Lyon J, Douglas JG. A randomised trial of home energy efficiency improvement in the homes of elderly COPD patients. Eur Respir J. 2010;35:303–309. doi: 10.1183/09031936.00187708.
    1. Celli BR. Chronic obstructive pulmonary disease: from unjustified nihilism to evidence-based optimism. Proc Am Thorac Soc. 2006;3:58–65. doi: 10.1513/pats.200510-111JH.
    1. Tsiligianni I, Kocks J, Tzanakis N, Siafakas N, van der Molen T. Factors of influence disease-specific quality of life of health status in patients with COPD: a systmatic review and meta-analysis of Pearson correlations. Primary Care Respir J. 2011;20:257–268. doi: 10.4104/pcrj.2011.00029.
    1. Burge PS. Prevention of Exacerbations. How are we doing and Can We Do Better? Proc Am Thorac Soc. 2006;3:257–261. doi: 10.1513/pats.200511-117SF.
    1. Evans J, Hyndman S, Stewart-Brown S, Smith D, Petersen S. An epidemiological study of the relative importance of damp housing in relation to adult health. J Epidemiol Community Health. 2000;54:677–686. doi: 10.1136/jech.54.9.677.
    1. Donaldson GC, Seemungal T, Jefferies DJ, Wedzicha JA. Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur Respir J. 1999;13:844–849. doi: 10.1034/j.1399-3003.1999.13d25.x.
    1. Davie GS, Baker MG, Hales S, Carlin J. Trends and Determinants of Excess Winter Mortality in New Zealand: 1980 to 2000. BMC Publ Health. 2007;7:263. doi: 10.1186/1471-2458-7-263.
    1. Aylin P, Morris S, Wakefield J, Grossinho A, Jarup L, Elliott P. Temperature, housing, deprivation and their relationship to excess winter mortality in Great Britain, 1986–1996. Int J Epidemiol. 2001;30:1100–1108. doi: 10.1093/ije/30.5.1100.
    1. Hurst JR, Donaldson GC, Wilkinson TMA, Perera WR, Wedzicha JA. Epidemiological relationships between the common cold and exacerbations frequency in COPD. Eur Respir J. 2005;26:846–852. doi: 10.1183/09031936.05.00043405.
    1. Wedzicha JA, Wilkinson T. Impact of Chronic Obstructive Pulmonary Disease Exacerbations on Patients and Payers. Proc Am Thorac Soc. 2006;3:218–221. doi: 10.1513/pats.200510-114SF.
    1. Isaacs N, Donn M. Health and housing - seasonality in New Zealand mortality. Australian J Public Health. 1993;17:68–70.
    1. Davie G. The seasons of "Six feet Under": Trends and Determinants of Excess Winter Mortality in New Zealand from 1980 to 2000. Partial requirement for Masters. Melbourne: Population Health; 2004.
    1. Hales S, Blakely T, Foster RH, Baker MG, Howden-Chapman P. Seasonal patterns of mortality in relation to social factors. J Epidemiol Commun Health. 2012.
    1. Isaccs N, Camilleri M, Burrough L, Pollard A, Saville-Smith K, Fraser R, Rossouw P, Jowett J. Energy Use in New Zealand Households: Final Report on the Household Energy End-use Project (HEEP) Judgeford New Zealand: BRANZ Ltd; 2010. .
    1. Isaacs N, Amintrano L, Camilleri M, Pollard A, Stoecklein A. Energy Use in New Zealand Households: Report on the Year 7 Analysis for the Household Energy End-use Project (HEEP) Judgeford New Zealand: BRANZ Ltd; 2003.
    1. Isaacs N, Amintrano L, Camilleri M, French L, Pollard A, Saville-Smith K, Fraser R, Rossouw P. Energy Use in New Zealand Households: Report on the Year 8 Analysis for the Household Energy End-Use Project (HEEP) Judgeford New Zealand: BRANZ Ltd; 2004.
    1. World Health Organization. WHO technical meeting on "Housing-Health Indicators World Health Organization Regional Office for Europe. 2004.
    1. Wright F. Old and Cold: Older People and Policies Failing to Address Fuel Poverty. Social Policy & Adm. 2004;38:488–503. doi: 10.1111/j.1467-9515.2004.00403.x.
    1. Department of Building and Housing. Compliance Document for New Zealand Building Code Clause G5 Interior Environment. Wellington, New Zealand; 2011.
    1. Howden-Chapman P, Signal L, Crane J. Housing and Health in Older People: Ageing in Place. Soc Policy J N Z. 1999;13:14–30.
    1. Rudge J, Gilchrist R. Excess winter morbidity among older people at risk of cold homes: a population-based study in a London borough. J Public Health. 2005;27:353–358. doi: 10.1093/pubmed/fdi051.
    1. Walker JJ, Mitchell R, Platt SD, Petticrew MP, Hopton J. Does usage of domestic heating influence internal environmental conditions and health? European J Public Health. 2006;16:463–469.
    1. Howden-Chapman P, Viggers H, Chapman R, O'Dea D, Free S, O'Sullivan K. Warm homes: Drivers of the demand for heating in the residential sector in New Zealand. Energy Policy. 2009;37:3387–3399. doi: 10.1016/j.enpol.2008.12.023.
    1. Howden-Chapman P, Crane J, Matheson A, Viggers H, Cunningham M, Blakely T, O'Dea D, Cunningham C, Woodward A, Saville-Smith K. Retrofitting houses with insulation to reduce health inequalities: Aims and methods of a clustered, randomised community-based trial. Social Scie & Med. 2005;61:2600–2610. doi: 10.1016/j.socscimed.2005.04.049.
    1. Howden-Chapman P, Matheson A, Crane J, Viggers H, Cunningham M, Blakely T, Cunningham C, Woodward A, Saville-Smith K, O'Dea D. Effect of insulating existing houses on health inequality: cluster randomised study in the community. British Med J. 2007;334:460–464. doi: 10.1136/bmj.39070.573032.80.
    1. Howden-Chapman P, Pierse N, Nicholls S, Gillespie-Bennett J, Viggers H, Cunningham M, Phipps R, Boulic M, Fjällström P, Free S. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ. 2008;337
    1. Boardman B. Fixing Fuel Poverty: Challenges and solutions. London: Earthscan; 2010.
    1. Hills J. Fuel Poverty: The problem and its measurement: interim report of the fuel poverty review. London: Centre for Analysis of Social Exclusion; 2012. .
    1. Liddell C, Morris C, McKenzie P, Rae G. Defining Fuel Poverty in Northern Ireland: A preliminary review. 2011.
    1. Rudge J, Nicol F. Cutting the Cost of Cold: Affordable Warmth for Healthier Homes. London: E & FN Spon; 2000.
    1. Ostensible hypothecation: the effect on fuel expenditure of cash transfers to the elderly for fuel. .
    1. Thaler RH, Shefrin HM. An Economic Theory of Self-Control. J Polit Econ. 1981;89:392–406. doi: 10.1086/260971.
    1. Thaler RH. Savings, fungability and mental accounts. J Econ Perspect. 1990;4
    1. Hong SH, Oreszczyn T, Ridley I. The Warm Front Study Group. The impact of energy efficient refurbishment on the space heating fuel consumption in English Dwellings. Energy and Buildings. 2006;38:1171–1181. doi: 10.1016/j.enbuild.2006.01.007.
    1. Howden-Chapman P, Viggers H, Chapman R, O’Sullivan K, Telfar Barnard L, Lloyd B. Tackling cold housing and fuel poverty in New Zealand: A review of policies, research, and health impacts. Energy Policy. 2012. pp. 134–142.
    1. Quarterly survey of domestic energy prices. .
    1. Dunn S. Qualitative Study of Home Heating Choices in Masterton. .
    1. Pauwels RA, Buist AS, Calverly PMA, Jenkins CR, Hurd SS. on behalf of GOLD scientific committee. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2001;163:1256–1276.
    1. Jensen J, Krishnan V, Hodgson R, Sathiyandra SG, Templeton R, Jones D, Goldstein-Hawes R, Beynon P. New Zealand Living Standards 2004. Wellington: Ministry of Social Development; 2006.
    1. Stephens DH. Sleeping snugly in cold damp bedrooms. J R Soc Promot Heal. 1982;102
    1. Calverley PMA, Anderson JA, Celli B, Feruson GT, Jenkins C, Jones PW, Yates JC, Vestbo J. Salmeterol and Fluticasone Propionate and Survival in Chronic Obstructive Pulmonary Disease. N Engl J Med. 2007;356:775–789. doi: 10.1056/NEJMoa063070.
    1. Keene ON, Jones MRK, Lane PW, Anderson J. Analysis of exacerbation rates in asthma and chronic obstructive pulmonary disease: example from the TRISTAN study. Pharmeceutical Stat. 2007;6:89–97. doi: 10.1002/pst.250.
    1. Cazzola M, MacNee W, Martinez FJ, Rabe KF, Franciosi LG, Barnes PJ, Brusasco V, Burge PS, Calverley PMA, Celli BR. Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J. 2008;31:416–469. doi: 10.1183/09031936.00099306.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. J Chronic Dis. 1987;40:373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Deyo RA, Cherkin DC, Ciol MA. Adapting a Clinical Comorbidity Index for use with ICD-9-CM Administrative Databases. J Clin Epidemiol. 1992;45:613–619. doi: 10.1016/0895-4356(92)90133-8.
    1. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. J Clin Epidemiol. 2004;57:1288–1294. doi: 10.1016/j.jclinepi.2004.03.012.
    1. Canterbury earthquake. .
    1. List of deceased. .
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CPM, Gustafsson P. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805.
    1. Chapman R, Howden-Chapman P, Viggers H, O'Dea D, Kennedy M. Retrofitting houses with insulation: a cost-benefit analysis of a randomised community trial. J Epidemiol Commun Health. 2009;63:271–277. doi: 10.1136/jech.2007.070037.
    1. Preval N, Chapman R, Pierse N, Howden-Chapman P. The Housing Heating and Health Group. Evaluating energy, health and carbon co-benefits from improved domestic space heating: A randomised community trial. Energy Policy. 2010;38:3965–3972. doi: 10.1016/j.enpol.2010.03.020.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa